Diabetes Metab J.  2023 Jul;47(4):547-558. 10.4093/dmj.2022.0026.

Ultra-Processed Food Consumption and Obesity in Korean Adults

Affiliations
  • 1Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
  • 2Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea

Abstract

Background
This study aimed to investigate the association between consumption of ultra-processed foods (UPF) and obesity in Korean adults.
Methods
We included the Cardiovascular and Metabolic Diseases Etiology Research Center cohort study baseline data of adults aged 30 to 64 years who completed a validated food frequency questionnaire. UPF was defined using the NOVA food classification. Multivariable linear and logistic regression analyses were performed to assess the association of dietary energy contribution of UPF with obesity indicators (body mass index [BMI], obesity, waist circumference [WC], and abdominal obesity).
Results
Consumption of UPF accounted for 17.9% of total energy intake and obesity and abdominal obesity prevalence was 35.4% and 30.2%, respectively. Compared with those in the lowest quartile of UPF consumption, adults in the highest quartile had greater BMI (β=0.36; 95% confidence interval [CI], 0.15 to 0.56), WC (β=1.03; 95% CI, 0.46 to 1.60), higher odds of having obesity (odds ratio [OR], 1.24; 95% CI, 1.07 to 1.45), and abdominal obesity (OR, 1.34; 95% CI, 1.14 to 1.57), after adjusting for sociodemographic characteristics, health-related behaviors, and family history of diseases. Dose-response associations between UPF consumption and obesity indicators were consistently found (all P trend <0.01). However, the strength of association was halved for all obesity indicators after further adjustments for total energy intake and overall diet quality score, and the trend toward association for obesity and WC disappeared.
Conclusion
Our finding supports the evidence that consumption of UPF is positively associated with obesity among Korean adults.

Keyword

Body mass index; Eating; Food handling; Obesity; Obesity, abdominal; Observational study; Waist circumference

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Reference

1. Kelly T, Yang W, Chen CS, Reynolds K, He J. Global burden of obesity in 2005 and projections to 2030. Int J Obes (Lond). 2008; 32:1431–7.
Article
2. Williams EP, Mesidor M, Winters K, Dubbert PM, Wyatt SB. Overweight and obesity: prevalence, consequences, and causes of a growing public health problem. Curr Obes Rep. 2015; 4:363–70.
Article
3. Kim DS, Scherer PE. Obesity, diabetes, and increased cancer progression. Diabetes Metab J. 2021; 45:799–812.
Article
4. GBD 2015 Obesity Collaborators, Afshin A, Forouzanfar MH, Reitsma MB, Sur P, Estep K, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017; 377:13–27.
Article
5. Kim Y, Nho SJ, Woo G, Kim H, Park S, Kim Y, et al. Trends in the prevalence and management of major metabolic risk factors for chronic disease over 20 years: findings from the 1998-2018 Korea National Health and Nutrition Examination Survey. Epidemiol Health. 2021; 43:e2021028.
Article
6. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014; 384:766–81.
7. Baker P, Friel S. Food systems transformations, ultra-processed food markets and the nutrition transition in Asia. Global Health. 2016; 12:80.
Article
8. Baker P, Machado P, Santos T, Sievert K, Backholer K, Hadjikakou M, et al. Ultra-processed foods and the nutrition transition: global, regional and national trends, food systems transformations and political economy drivers. Obes Rev. 2020; 21:e13126.
Article
9. James P, Seward MW, James O’Malley A, Subramanian SV, Block JP. Changes in the food environment over time: examining 40 years of data in the Framingham Heart Study. Int J Behav Nutr Phys Act. 2017; 14:84.
10. Kim S: Changes in food consumption in Korea. Available from: https://ap.fftc.org.tw/article/1355 (updated 2018 Nov 14).
11. Monteiro CA, Moubarac JC, Cannon G, Ng SW, Popkin B. Ultra-processed products are becoming dominant in the global food system. Obes Rev. 2013; 14 Suppl 2:21–8.
Article
12. Monteiro CA, Cannon G, Levy RB, Moubarac JC, Louzada ML, Rauber F, et al. Ultra-processed foods: what they are and how to identify them. Public Health Nutr. 2019; 22:936–41.
Article
13. Monteiro CA, Cannon G, Moubarac JC, Levy RB, Louzada ML, Jaime PC. The UN decade of nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutr. 2018; 21:5–17.
Article
14. Elizabeth L, Machado P, Zinocker M, Baker P, Lawrence M. Ultra-processed foods and health outcomes: a narrative review. Nutrients. 2020; 12:1955.
Article
15. Lawrence MA, Baker PI. Ultra-processed food and adverse health outcomes. BMJ. 2019; 365:l2289.
Article
16. Adams J, White M. Characterisation of UK diets according to degree of food processing and associations with socio-demographics and obesity: cross-sectional analysis of UK National Diet and Nutrition Survey (2008-12). Int J Behav Nutr Phys Act. 2015; 12:160.
Article
17. Sung H, Park JM, Oh SU, Ha K, Joung H. Consumption of ultra-processed foods increases the likelihood of having obesity in Korean women. Nutrients. 2021; 13:698.
Article
18. Monteiro CA, Moubarac JC, Levy RB, Canella DS, Louzada ML, Cannon G. Household availability of ultra-processed foods and obesity in nineteen European countries. Public Health Nutr. 2018; 21:18–26.
Article
19. Silva FM, Giatti L, de Figueiredo RC, Molina MD, de Oliveira Cardoso L, Duncan BB, et al. Consumption of ultra-processed food and obesity: cross sectional results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort (2008-2010). Public Health Nutr. 2018; 21:2271–9.
Article
20. Juul F, Martinez-Steele E, Parekh N, Monteiro CA, Chang VW. Ultra-processed food consumption and excess weight among US adults. Br J Nutr. 2018; 120:90–100.
Article
21. Nardocci M, Polsky JY, Moubarac JC. Consumption of ultraprocessed foods is associated with obesity, diabetes and hypertension in Canadian adults. Can J Public Health. 2021; 112:421–9.
Article
22. Sandoval-Insausti H, Jimenez-Onsurbe M, Donat-Vargas C, Rey-Garcia J, Banegas JR, Rodriguez-Artalejo F, et al. Ultraprocessed food consumption is associated with abdominal obesity: a prospective cohort study in older adults. Nutrients. 2020; 12:2368.
Article
23. Machado PP, Steele EM, Levy RB, da Costa Louzada ML, Rangan A, Woods J, et al. Ultra-processed food consumption and obesity in the Australian adult population. Nutr Diabetes. 2020; 10:39.
Article
24. Beslay M, Srour B, Mejean C, Alles B, Fiolet T, Debras C, et al. Ultra-processed food intake in association with BMI change and risk of overweight and obesity: a prospective analysis of the French NutriNet-Sante cohort. PLoS Med. 2020; 17:e1003256.
25. Rauber F, Chang K, Vamos EP, da Costa Louzada ML, Monteiro CA, Millett C, et al. Ultra-processed food consumption and risk of obesity: a prospective cohort study of UK Biobank. Eur J Nutr. 2021; 60:2169–80.
Article
26. Mendonça RD, Pimenta AM, Gea A, de la Fuente-Arrillaga C, Martinez-Gonzalez MA, Lopes AC, et al. Ultraprocessed food consumption and risk of overweight and obesity: the University of Navarra Follow-Up (SUN) cohort study. Am J Clin Nutr. 2016; 104:1433–40.
27. Shim JS, Shim SY, Cha HJ, Kim J, Kim HC. Socioeconomic characteristics and trends in the consumption of ultra-processed foods in Korea from 2010 to 2018. Nutrients. 2021; 13:1120.
28. Moubarac JC, Batal M, Martins AP, Claro R, Levy RB, Cannon G, et al. Processed and ultra-processed food products: consumption trends in Canada from 1938 to 2011. Can J Diet Pract Res. 2014; 75:15–21.
29. Martinez Steele E, Juul F, Neri D, Rauber F, Monteiro CA. Dietary share of ultra-processed foods and metabolic syndrome in the US adult population. Prev Med. 2019; 125:40–8.
30. Slimani N, Deharveng G, Southgate DA, Biessy C, Chajes V, van Bakel MM, et al. Contribution of highly industrially processed foods to the nutrient intakes and patterns of middle-aged populations in the European Prospective Investigation into Cancer and Nutrition study. Eur J Clin Nutr. 2009; 63 Suppl 4:S206–25.
Article
31. Shim JS, Song BM, Lee JH, Lee SW, Park JH, Choi DP, et al. Cohort profile: the Cardiovascular and Metabolic Diseases Etiology Research Center cohort in Korea. Yonsei Med J. 2019; 60:804–10.
32. Shim JS, Song BM, Lee JH, Lee SW, Park JH, Choi DP, et al. Cardiovascular and Metabolic Diseases Etiology Research Center (CMERC) cohort: study protocol and results of the first 3 years of enrollment. Epidemiol Health. 2017; 39:e2017016.
Article
33. Yun SH, Shim JS, Kweon S, Oh K. Development of a food frequency questionnaire for the Korea National Health and Nutrition Examination Survey: data from the fourth Korea National Health and Nutrition Examination Survey (KNHANES IV). Korean J Nutr. 2013; 46:186–96.
Article
34. Kim DW, Song S, Lee JE, Oh K, Shim J, Kweon S, et al. Reproducibility and validity of an FFQ developed for the Korea National Health and Nutrition Examination Survey (KNHANES). Public Health Nutr. 2015; 18:1369–77.
Article
35. Ministry of Health and Welfare; Korea Centers for Disease Control and Prevention. Guidelines for nutrition survey: Korea National Health and Nutrition Examination Survey 6th (2013-2015). Cheongju: KCDC;2015.
36. Korean Society for the Study of Obesity. Quick reference guideline 2020. Seoul: Committee of Clinical Guidelines, Korean Society for the Study of Obesity;2020.
37. Chun MY. Validity and reliability of Korean version of international physical activity questionnaire short form in the elderly. Korean J Fam Med. 2012; 33:144–51.
Article
38. Yun S, Oh K. Development and status of Korean Healthy Eating Index for adults based on the Korea National Health and Nutrition Examination Survey. Public Health Wkly Rep. 2018; 11:1764–72.
39. Shim JS, Shim SY, Cha HJ, Kim J, Kim HC. Association between ultra-processed food consumption and dietary intake and diet quality in Korean adults. J Acad Nutr Diet. 2022; 122:583–94.
Article
40. Vandevijvere S, Jaacks LM, Monteiro CA, Moubarac JC, Girling-Butcher M, Lee AC, et al. Global trends in ultraprocessed food and drink product sales and their association with adult body mass index trajectories. Obes Rev. 2019; 20 Suppl 2:10–9.
Article
41. Hall KD, Ayuketah A, Brychta R, Cai H, Cassimatis T, Chen KY, et al. Ultra-processed diets cause excess calorie intake and weight gain: an inpatient randomized controlled trial of ad libitum food intake. Cell Metab. 2019; 30:67–77.
Article
42. Spiteri SA, Olstad DL, Woods JL. Nutritional quality of new food products released into the Australian retail food market in 2015: is the food industry part of the solution? BMC Public Health. 2018; 18:222.
43. Rauber F, Louzada ML, Martinez Steele E, Rezende LF, Millett C, Monteiro CA, et al. Ultra-processed foods and excessive free sugar intake in the UK: a nationally representative cross-sectional study. BMJ Open. 2019; 9:e027546.
Article
44. Poti JM, Braga B, Qin B. Ultra-processed food intake and obesity: what really matters for health-processing or nutrient content? Curr Obes Rep. 2017; 6:420–31.
Article
45. Carter A, Hendrikse J, Lee N, Yucel M, Verdejo-Garcia A, Andrews ZB, et al. The neurobiology of “food addiction” and its implications for obesity treatment and policy. Annu Rev Nutr. 2016; 36:105–28.
Article
46. Paula Neto HA, Ausina P, Gomez LS, Leandro JG, Zancan P, Sola-Penna M. Effects of food additives on immune cells as contributors to body weight gain and immune-mediated metabolic dysregulation. Front Immunol. 2017; 8:1478.
Article
47. Di Ciaula A, Portincasa P. Diet and contaminants: driving the rise to obesity epidemics? Curr Med Chem. 2019; 26:3471–82.
Article
48. Shim JS, Oh K, Kim HC. Dietary assessment methods in epidemiologic studies. Epidemiol Health. 2014; 36:e2014009.
Article
49. Food and Agriculture Organization of the United Nations (FAO). Guidelines on the collection of information on food processing through food consumption surveys. Rome: FAO;2015.
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